Yoga Therapist Training Application
Date *
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Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
At what school did you complete your 200hr Teacher Training?
You may still complete this section if you are currently enrolled in a 200hr Training
Name of School *
Your answer
Dates Attended *
Your answer
Address of School *
Your answer
Contact Person *
Your answer
Telephone of School *
Your answer
Website of School *
Your answer
Did you complete a 300hr or 500hr Training? *
At what school did you complete your 300hr or 500hr Teacher Training?
You may still complete this section if you are currently enrolled in a 300hr or 500hr Training
Name of School *
Your answer
Dates Attended *
Your answer
Address of School *
Your answer
Contact Person *
Your answer
Telephone of School *
Your answer
Website of School *
Your answer
Transfer Credit Option
Up to 300 hours maximum of Transfer Credit may be applied to the Yoga Therapy if all criteria are met.
Do you wish to receive the Transfer Credit Application *
Your Yoga History
How long have you been teaching Yoga? *
Your answer
Please list the places where you have taught Yoga. Include the name of the Center, Start Date, Number of Classes Taught per Week/Month: *
Your answer
Have you done any other training/continuing education since you finished your official training(s)? If so, please list them: *
Your answer
Do you hold any other degrees or certifications in any additional healing modalities? If so, please list them: *
Your answer
How long have you been in this healing profession? *
Your answer
Please tell us about your healing practice. What drives you to do it? *
Your answer
What is your passion as it relates to teaching Yoga? *
Your answer
What is you passion as it relates to being a Yoga Therapist? *
Your answer
Where do you practice Yoga currently? *
Your answer
What tradition(s) or style(s) do you practice? *
Your answer
Do you practice mediation regularly? *
If yes, how often do you practice? *
Your answer
How did you first learn about this training? *
Your answer
Please tell us your reasons for taking this training *
Your answer
Do you have any other information to share about attending this program?
Your answer
Medical Questionairre
All responses are strictly confidential. We use this information only to better assist you during the program, not to screen participants, unless participation would be medically inadvisable.
Date of Birth *
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Please briefly describe your current overall health *
Your answer
Describe any history (include dates) or back/spine/neck problems and indicate whether they are still problematic. Please be specific. *
Your answer
Describe any history (include dates) of join problems (knee/hip/shoulder/etc), including joint repair/replacement surgeries. Please be specific. *
Your answer
Blood Pressure *
When was your blood pressure last checked? *
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Have you ever taken blood pressure medication? *
If yes, how recently? *
Your answer
Describe any history (even if you are at risk) of cardiovascular problems *
Your answer
Have you ever experienced any of the following difficulties? *
Required
Women: Are you pregnant? *
If yes, when is your baby due?
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Do you have any other limitations, dietary restrictions, or health concerns? If so, please explain *
Your answer
If you have any learning disabilities or other special physical or psychological circumstances, please explain so we can better serve you during this program *
Your answer
Emergency Contact
Name *
Your answer
Relation *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
I hereby certify that the above information is correct to the best of my knowledge *
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